ECT EFFECTS ON CEREBRAL PERFUSION

ECT 对脑灌注的影响

• 批准号: 6185316
• 负责人: MITCHELL S NOBLER
• 金额: $ 15.8万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-05-01 至 2002-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6185316
• 关键词: brain circulation; clinical research; electroconvulsive therapy; human subject; human therapy evaluation; magnetic resonance imaging; major depression; mental disorder chemotherapy; nortriptyline; positron emission tomography; psychopharmacology; radiopharmacology; single photon emission computed tomography

This revised application requests a Scientist Development Award for Clinicians to study the neurophysiological correlates of clinical response in patients with major depression treated with electroconvulsive therapy (ECT) or with nortriptyline. There is evidence that subgroups of patients suffering from depression have abnormalities in cerebral blood flow (CBF) and cerebral metabolic rate for glucose (CMR). ECT and nortriptyline are effective forms of somatic therapy for depression, yet relatively little is known about their impact on neuroimaging measures. The major goal of this work is to better define neurophysiological indices that are related to successful treatment with ECT or with medications, as well as abnormalities that remain constant despite antidepressant response. I have collected substantial preliminary data that suggest that acute reductions in global CBF and in specific topographic patterns are predictive of positive clinical response to ECT. These acute reductions are superimposed on abnormal baseline values. other preliminary findings suggest that 'deepened' hypofrontality is also associated with clinical response to antidepressant medications. I propose to be trained in the radiopharmacology and clinical applications of neuroimaging with positron emission tomography (PET), single photon emission computerized tomography (SPECT) and magnetic resonance imaging (MRI), biostatistics, advanced approaches to image analysis, and the theoretical and practical aspects of psychopharmacology and ECT. There is evidence that relatively elderly and severely depressed patients may have both state and trait abnormalities in cortical CBF. Little is known about the impact of ECT or medications on these abnormalities. Under this award, I would extend preliminary evidence from planar xenon rCBF studies, and use 150-water and FDG PET to assess acute and short-term changes in cortical and subcortical CBF and CMR that are associated with response to ECT. Concurrently, I will use SPECT to examine changes in CBF following treatment with nortriptyline. Future studies may use PET to assess change in CMR with nortriptyline. I hypothesize that, with both ECT and nortriptyline, decreased manifestation of an anterior/posterior gradient, or deepened hypofrontality, is associated with positive clinical outcome. Exploratory analyses will examine the relations of CBF and CMR changes to the amnestic side effects of ECT, as well as covariance with other behavioral and physiological measures that may predict treatment outcome. Ultimately, I hope to determine the extent to which alterations in discrete functional brain systems provide necessary and/or sufficient conditions for the antidepressant effects of somatic treatment and extend this research by exploring the neurochemical bases for these alterations.

该修订后的申请请求颁发科学家发展奖 临床医生研究临床反应的神经生理学相关性 用电抽搐治疗治疗的严重抑郁症患者 （ECT）或使用氯替林。有证据表明患者亚组 患有抑郁症的脑血流异常（CBF） 葡萄糖（CMR）的脑代谢率。 ECT和Nortriptyline是 抑郁症的有效形式的躯体疗法，但相对较少 知道它们对神经影像措施的影响。主要目标 这项工作是为了更好地定义相关的神经生理指数 通过ECT或用药物成功治疗 尽管反应反应，但仍保持恒定的异常。我有 收集了大量的初步数据，这表明急性减少 在全球CBF和特定的地形模式中 对ECT的阳性临床反应。这些急性减少是叠加的 在异常基线值上。其他初步发现表明 “加深”的低焦性也与临床反应有关 抗抑郁药。 我建议对放射性药理学和临床应用进行培训 神经影像与正电子发射断层扫描（PET），单个光子 排放计算机断层扫描（SPECT）和磁共振成像 （MRI），生物统计学，图像分析的先进方法和 心理药理学和ECT的理论和实际方面。有 证据表明相对老年和严重抑郁的患者可能患有 皮质CBF的状态和性状异常。对 ECT或药物对这些异常的影响。在此奖项下， 我将从平面Xenon RCBF研究中扩展初步证据，并 使用150水和FDG PET评估急性和短期变化 皮质和皮质下CBF和CMR，与对 ect。同时，我将使用SPECT检查CBF的更改。 用诺替林治疗。未来的研究可能会使用PET评估变更 在CMR中，带有Nortriptyline。我假设这是与ECT和 去甲替林，前/后梯度的表现降低， 或加深的缺血，与阳性临床结果有关。 探索性分析将检查CBF和CMR的关系变化 ECT的敏感副作用以及与其他的协方差 行为和生理措施，可以预测治疗结果。 最终，我希望确定改变的程度 离散功能性脑系统提供必要和/或足够 体细胞治疗的抗抑郁作用的条件并延伸 这项研究通过探索这些改变的神经化学基础。

项目成果

Quantitative EEG during seizures induced by electroconvulsive therapy: relations to treatment modality and clinical features. II. Topographic analyses.

电休克治疗引起的癫痫发作期间的定量脑电图：与治疗方式和临床特征的关系。

• DOI: 10.1097/00124509-200009000-00003
• 发表时间: 2000
• 期刊: The journal of ECT.
• 作者: Luber,B;Nobler,MS;Moeller,JR;Katzman,GP;Prudic,J;Devanand,DP;Dichter,GS;Sackeim,HA
• 通讯作者: Sackeim,HA

Effects of medications on cerebral blood flow in late-life depression.

药物对晚年抑郁症脑血流量的影响。

• DOI: 10.1007/s11920-002-0013-x
• 发表时间: 2002
• 期刊: Current psychiatry reports
• 影响因子: 6.7
• 作者: Nobler,MitchellS;Olvet,KristianR;Sackeim,HaroldA
• 通讯作者: Sackeim,HaroldA